“President Obama began throwing seniors off the cliff when they voted to cut Medicare’s budget by $575 billion.”

— Narration from an ad by AmericanDoctors4Truth

This ad parodies a previous video from The Agenda Project, which ran a similar spot suggesting that Republicans were trying to end Medicare and privatize it with a proposal from House Budget Committee Chairman Paul Ryan (R-Wis.). Our colleagues at FlackCheck.org ran a film-noir parody covering both of these commercials.

The AmericanDoctors4Truth video shows a senior in a wheelchair explaining that she needs a pacemaker, while a fictional President Obama pushes her toward a scenic overlook. “You know what, maybe this isn’t going to help,” the president says. “Maybe you’re better off not having the surgery, but taking the painkiller.”

The fictional president then dumps granny over the cliff, and a narrator explains that the Affordable Care Act strips $575 billion from Medicare. The ad then cuts to a series of brief commentaries by two physicians, who plead with viewers to join in their fight against the health-care law. A longer four-minute version on the Doctors4Truth Web site explains that the law will lead to rationing of medical services.

We examined the Affordable Care Act and talked with experts to determine whether the claims in this ad are true.

The Facts

The Affordable Care Act didn’t exactly “cut” $575 billion from Medicare. Instead, it laid out plans to wring that much in savings, from projected spending, over a 10-year span. What’s the difference? The government is still on the hook to pay the difference if it doesn’t reach its goal.

We covered this issue in a previous column, but we’ll do a quick review. The Medicare portion of the health-care law pinches care providers and some beneficiaries — particularly those with higher incomes — in order to cut costs. It is also expected to put the program on a more solid financial footing in the future. (See page 8 of the 2010 report from the chief actuary of the Center for Medicare and Medicaid Services for a breakdown of how the government plans to achieve savings.)

It’s worth noting that the law also improves benefits for some senior citizens by making preventive care free and by reducing drug payments for those who fall into the “doughnut hole” — the point at which an individual exceeds the coverage limit for prescriptions.

Obama’s line about choosing painkillers instead of surgery comes from an interview with ABC Primetime Live in 2009. His statement deserves some context. (ABC posted the full transcript on its Web site).

The president was responding to a woman’s anecdote about a heart specialist who resisted giving her 100-year-old mother a pacemaker. The doctor thought the elderly woman was too old for the device to do much good, but he finally relented.

Interviewer Charlie Gibson asked the president what should happen if money is too tight for such medical procedures. “I don’t want bureaucracies making those decisions, but understand that those decisions are already being made in one way or another,” the president said. “If they’re not being made under Medicare or Medicaid, they’re being made by private insurers.”

Obama then talked about cutting waste from the health-care system, specifically by avoiding procedures that are not proven to improve care. That’s when he made the comment about painkillers over surgery.

This was a gaffe on the president’s part, but he clarified his overarching message later in the interview when he said that “the point is, we want to use science, we want doctors and medical experts to be making decisions that all too often right now are driven by skewed policies, by outdated means of reimbursement, or by insurance companies.”

The caretaker daughter said that giving her mother a pacemaker earlier could have saved money for the Medicare system, because her mom, who was still alive at age 105 at the time of the interview, had visited the hospital some 30 times with heart problems before the operation.

Obama acknowledged that experts need to improve the system so that those savings can be realized — sometimes through surgery. “This can cut both ways,” he said.

As for the rationing issue, we covered that in our previous column, but the main points to remember are that “rationing” is in the eye of the beholder, and the Affordable Care Act expressly prohibits the new Medicare payment-advisory panel from making recommendations to “ration health care, raise revenues or Medicare beneficiary premiums.” (See page 409 of the final bill).

Anup Malani, a professor of health law at the University of Chicago who specializes in health economics, said that the panel is less likely to restrict coverage than expand it, as the Department of Health and Human Services recently did by requiring insurance providers to cover the full cost of birth control.

Malani also noted that the medical industry has been rather successful in lobbying Congress to overturn policies aimed at cutting Medicare and Medicaid costs by restricting tests or procedures.

As for spillover into the private sector, the experts we spoke with agreed that it’s likely to happen. “Insurance companies want Medicare to take the flack for hard decisions,” said Mark Pauly, a medical economics expert and professor of health care management at the Wharton School at the University of Pennsylvania. “If Medicare has the nerve to say no first, they’re more likely to follow suit.”

The two physicians who appear in the shortened version of the Doctors4Truth ad are San Antonio-based ophthalmologists Kris Held and Jane Hughes, who work for separate practices.

We reached Held while she was between the operating room and the University of Texas Health Science Center at San Antonio, where she works as a clinical faculty member. She showed a profound knowledge of the Affordable Care Act and its surrounding issues.

Held said her greatest fear with the Affordable Care Act is that government will interfere with the doctor-patient relationship, forcing people to accept substandard care. But she acknowledged that private insurance presents the same problem, at least as it stands today. Overall, she said she wants reform, just not the program that Obama signed into law.

“I’ve wanted to love this law,” Held said. “We’ve got to have reform so all our patients are covered, but this just gives them a pink slip. People could be rationed right out.”

“I do not come at this lightly,” she added. “This [ad] is something that to the deep core of my soul I think is true and accurate representation.”

The Pinocchio Test

Saving money does not have to involve harmful restrictions. For instance, people can reduce expenses by packing lunches instead of eating out or buying cafeteria food. They spend less money that way, and no harm is done.

Experts disagree on whether the Affordable Care Act’s Medicare provisions will lead to rationing or just smarter health-care decisions — the law itself forbids rationing. The president has said he wants the latter, and he helped create the health-care law with that goal in mind. Critics can argue that “Obamacare” won’t work as planned, but they’re talking about speculation and worst fears, not a proven reality.

We can give Doctors4Truth some leeway for sensationalistically throwing granny over a cliff, since the group was mocking a previous over-the-top ad that attacked Republican proposals. But we can’t overlook how the group presented conjecture — the rationing notion — as fact.

In the end, this ad represents a “true and accurate representation” of critics’ fears, not of certain reality. It deserves two Pinocchios.

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Comments our editors find particularly useful or relevant are displayed in Top Comments, as are comments by users with these badges: . Replies to those posts appear here, as well as posts by staff writers.